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Identification Typhoid fever is caused by the typhoid bacillus, Salmonella typhi. Currently, there are 107 known strains of the bacteria. S. typhi is a facultative anaerobic, Gram-negative rod and is part of the Enterobacteriaceae family. The bacterium is strictly a human pathogen. Typhoid fever affects approximately 17 million people globally each year and causes 600,000 deaths. In the industrialized nations, typhoid outbreaks have been virtually eliminated. In fact, most cases reported in these countries have been imported by travelers from endemic areas. Multi-drug resistance has been noted in Asia, the Middle East and Latin America. Laboratory indicators:
Pathogenesis Typhoid fever is spread by food and water contaminated by urine and/or faeces of infected individuals. Polluted water is the most common source of contamination. Additionally, shellfish collected from contaminated water sources and vegetables grown soil fertilized with faeces and eaten raw can be sources of infection. The disease is also spread via asymptomatic carriers, the most famous being "Typhoid Mary" in the early part of the 20th century. Working as a cook, she infected at least 47 people, causing the deaths of three, and was eventually quarantined on North Brother Island. In asymptomatic carriers, the organisms colonize in the gall bladder where they are excreted in faeces. After ingestion, the organisms multiply in the intestines and move into the bloodstream where they are carried to the lymph nodes. From there, they spread to the organs, leading to re-infestation of the GI tract. Manifestations Symptoms can occur 1-3 weeks after infection. The disease is characterized by a sudden fever, severe headache, nausea, loss of appetite, constipation or sometimes diarrhea. Treatment Infection is determined by growing cultures from stool samples on MacConkey's agar or EMB. Ampicillin, ceftriaxone, and chloramphenicol are all used in the treatment of typhoid fever. Patients given antibiotics generally feel better within 2-3 days, and deaths are rare. However, without treatment, as many as 20% may die due to complications of the infection. Prevention Chlorination of public water supplies and adequate sewage management systems aid in the prevention of typhoid epidemics. Frequent and thorough hand washing is essential, particularly following a bowel movement. The disease can be easily spread to a large number of people by food preparers who have not observed proper sanitary techniques. For people who travel internationally to endemic areas, immunization is highly recommended. Do not drink unbottled water that has not been boiled for at least one minute. Request drinks without ice and avoid products that could have been made with contaminated water. Avoid eating raw vegetables and fruits that cannot be peeled. When fruits are eaten, peel them yourself and wash your hands thoroughly. "Boil it, cook it, peel it, or forget it" |
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